HomeMy WebLinkAboutAPPLICATIONS, CO - 06-00317 - 365 Eagle Summit St - New SFRi
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CITY O P
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Amerita's Family Community
Certificate of Occupancy
City of Rexburg
Department of Community Development
19 E. Main St. / Rexburg, ID. 83440
e
/ Fax
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Construction:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
Contractor:
Special Conditions:
Occupancy:
06 00317
Intemational Residential Code 2003
365 Eagle Summit St
Residential
Type V-N, Unprotected
Single Family Residence
No
Cedarview Homes
298 Oaktrail Dr
Re~urg, ID 83440
Cedarview Homes
This Certificate, issued pursuant to the requirements of Section 909 of the Intemational Building
Code, certifies that, at the time time of issuance, this building or that portion of the building that
wes inspected on the date listed saes found to be in compliance Inith the requirements of the code
for the group and division of occupancy and the use for vihich the proposed occupancy yes
classified.
Date C.O. Issued: November 20l?~09~"(1J3:4~M)
C.O Issued by:
Building Official
There shall be no further change in the ebsting occupancy classification of the building nor shall any structural changes,
modifications or additions be made to the building or any portion thereof until the Building Official has reviewed and approved
said future changes.
Plumbing Inspector: ((''yy~~ Fire Inspector:
Electrical Inspector: ~ .___ ~dL ~ P~ZAdministrator:~1 ~~
Building Safety Department
City of Rexburg
19 E Main janellh@rexburg.org Phone: 208.359.3020 x326
Rexburg, ID 83440 www.rexburg.org Fax: 208.359.3024
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REXIiURG
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America's Family Community
OWNER'S NAME '~. '~~Y~~
PROPERTY ADDRESS 3(9 ~2 ~ Svrrt/yt~r
SUBDIVISION C ` ~ t ~'' -~-~ ~
PHASE LOT BLOCK c~_
Permit # 06 00317
365 Eagle Summit
Required.!!
ELECTRICAL
Electrical Contractor's Name __.~J -~°~ t~~ ~t°('~-~~t' Business Name
Address `~ ~ ~ N ~ s00
City ~ 0 State L Zip $~~.5
Cell Phone (zog) '~ 5 ( ~ C) 3 S Business Phone ( ) Sc~i2
Fax (zeg) _ tai ~~ ~ (~y pp Email
Electrical Estimate (cost of wiring & labor) $ ~• a ~~ (COMMERCIAL/MULTI-FAMILY ONLY)
TYPES OFINSTALLATION(RESIDENTIAL)
(New Residential includes everything contained within the residential structure and attached garage at the same time)
k Up to 200 amp Service*
201 to 400 amp Service*
Over 400 amp Service*
Temporary Construction Service, 200 amp or less, one location (for a period not to exceed 1 year)
Existing Residential (# of Branch Circuits)
Spa, Hot Tub, Swimming Pool
Electric Central Systems Heating and/or Cooling (when not part of a new residential construction permit
and no additional wiring)
Modular, Manufactured or Mobile Home
Other Installations: Wiring not specifically covered by any of the above
Cost of Wiring & Labor: $
Pumps (Domestic Water, Irrigation, Sewage)
Requested Inspections (of existing wiring)
Temporary Amusement/Industry
*Includes a maximum of/3 inspections. r~dditional inspections charged at requested inspection rate of $40 per hour.
Signature of Licensed Contractor License number Date
The
schedule is the came as required by the State of Idaho
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CITY OF REXB URG
PERMIT # ~ ~;~ ~~ ~ry'~-
BUILDING PERMIT APPLICATION Please cc
19 E MAIN, REXBURG, ID. 83440 If the questi~ Q6 QQ3 ~ 7
208-359-3020 X326 365 Eagle Summit-Jensen
PARCEL NUMBER: ~ ~ ~1~ ~ ~ ~ ~~ ~'~~~~ ~~ ~ii (We
SUBDIVISION:_ ~ g~ I G L~~ c~.n-~C UNIT# BLOCK# Z LOT# ~ ~
(Addressing is based on the information -must be accurate)
OWNER NAME: CuCaa.u ~e.~.~., /-~o v~ ~ CONTACT PHONE # (~ S 6 - O O o ~
PROPERTY ADDRESS: 3 6~ ~. ~ ~ Svc,,,,. y~ %~-
PHONE #: Home ( ) Work ( ) ~ fa - $O~ ~' Cell ( ) 3S /- t Z.. L /
OWNER MAILING ADDRESS: Zq $ p A-1C..7~~ ~ CITY: ~ v STATE:~ZIP;
EMAILl1/l/4-R-lt..- ~+ ~ c~( ~Do ~~.a.T~'IZ//t.~Cc ; o FAX 3S~D -'~ Z ~ ~"
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent for owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS
CITY:
STATE; ZIP EMAIL
PHONE #: Home
Work
FAX
Cell ( )
CONTRACTOR:
MAILING ADDRESS: 6,g/L~_~ ~ CITY c., STATE~ZIP 83~~p
PHONE #: Home ( ) Work ( )~ ~, -gO~t' ct' Cell ( )
EMAIL FAX IDAHO REGISTRATION # & EXP. DATE ` 2
How many buildings are located on this property?
Did you recently purchase this property? No Yes (If yes give owner's name)
Is this a lot spli .~_._.J YES (Please bring copy of new legal description of property)
PROPOSED USE:
(i ., mgle Family Residenc Multi Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.)
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify
that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me
in hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply
with all City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter
upon the above-mentioned property for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the
provisions of the 2003 International Code in cases of any false statement or misrepresentation of fact in the application or on the plans on which the
permit or approval was based. Perm' void if not started within 180 days. Permit void if work stops for 180 days.
of
~i / ~ i o :~
DATE
Do you prefer contacted by fax, email o phone Circle One
WARNING -BUILDING PE UST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning January 1.2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application** **Building Permits are void if your check does not clear**
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CITY O F
REXI3URG
America's Family Community
•
BUILDING SAFETY DEPARTMENT
19 E. Main (PO Box 280) Phone: 208-359-3020 x326
Rexburg, Idaho 83440 Fax: 208-359-3024
www.rexburg.orq ianellh rexburq.org
Affidavit of Legal Interest
State of Idaho
County of Madison
I, /'lilrl ~z-`~-. ~Gvcs ti Z28' ~ ~-k--r-R-~'-r L
Name Address
~i ~b~~
city
~s~
State
Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
A. That I am the record owner of the property described on the attached, and I grant my
permission to:
Name Address
to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulting from any dispute as to the statements contained herein or as to
the ownership of the property which is the subject of the application.
Dated this J ~ ~ day of _~U y1,L. , 20 0 ~
,.
Subscribed and sworn to before me the dci'year first above written.
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cP~ ~VB LIC
~~~~~~/yTF OF IDP~~`\\\`~
/~ ~ ~ ~ ~ 1 / 1 I I 114 1111 \ \ \ \ \\\~
Notary Pu c of Idaho
Residing at: ~ 6tC t~ ,~-,
My commission expires: ~~~_ ~~,~
2
' Please com l •' -
p ete the entire Application.
If the question does not apply fill in NA for non applicable
NAME C'~Ca.a..u~ c~ /~-P.a'yH, •~ L[.,L,
PROPERTY ADDRESS 3(o(S ~,,~ ~„ ~,~,,w,;, {{ Permit#
SUBDIVISION '~~ ~~,~
Dwelling Units: Parcel Acres:
SETBACKS
FRONT 31J SIDE 2 O SIDE ZO BACK
Remodeling Your Building/Home (need Estimate) $
SURFACE SQUARE FOOTAGE: (Shall include the exterior wall measurements of the building)
First Floor Area i
Second floor/loft area
Third floor/loft area
Shed or Barn
Unfinished Basement area
Finished basement area Zo {~ -6
Garage area ~ ~(~
Carport/Deck (30" above grade)Area
Water Meter Quantity:
************** Water Meter Size: ~/~ ~
Required!!!
PLUMBING
Plumbing Contractor's Name: ~c.*~b tj rt ~~ uwL b ~,;~ Business Name:
Address
Contact Phone:
Email
o b ~6
City JZ~ v~ State~~ Zip
~Tlo- R~~~_Business Phone: ( )
FIXTURE COUNT (including roughed fixtures)
~_ Clothes Washing Machine
~_ Dishwasher
~_ Floor Drain
_~ Garbage Disposal
Hot Tub/Spa
y~ Sinks
(Lavatories, kitchens, bar, mop)
Plumbing Estimate $
(Commercial Only)
Signature of Licensed Contractor
The City of Rexburg's
Tub/Showers ~
~_ Toilet/Urinal
Water Heater
License number
e schedule is the same as
Water Softener
Date
the State of Idaho
Fax
Sprinklers
4
PICaSe COrilplete the entlre AppllCatlOn ~ If the question does not apply fill in NA for non
applicable
NAME Cc c~~1-R..a ~ eau f-~ W+ ~ Z~ct
PROPERTY ADDRESS 3 ~S Z~.ws ~ Sumw,,i bd Permit#
SUBDIVISION ~,,~~ ~~~
Required!!! MECHANICAL
~t~~,
Mechanical Contractor's Name: _ I~ c~- to y r~ ~ )b d- Business Name:
Address City ~crt.tnu ~,.~ State L ~ Zip
Contact Phone: ( ) 3 S"b- ~4'i"Lp Business Phone: ( )
Email Fax
Mechanical Estimate $ (CommerciaVMulti Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Z Exhaust or Vent Ducts < <-=
~_ Furnace/Air Conditioner Combo 1'- ~ 1 Dryer Vents i
Heat Pump
Air Conditioner
Evaporative Cooler
Unit Heater
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
Fuel Gas Pipe Outlets including stubbed in or future outlets 5~%
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that app)~~ Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Applic__ation
Point of Delivery must be shown on plans.
Signature of Licensed Contractor
The City of
License number
i ~, j~~
Date
's permit fee schedule is the same as required by the State ofldaho
Range Hood Vents ~,~-
Cook Stove Vents
~ Bath Fan Vents ~
other similar vents & ducts:
5
. •
SUBCONTRACTOR LIST
Excavation & Earthwork: <'eoGa.~.p e t rvl- Csan.~- ~.. L L
Concrete: (' ~ t,.~~-y y c. n y~.C ~~ c
Masonry: (~ p-- y~ 7f~- SSc., ~- ~ o rv)
Roofing: ~G ~ n ~ c-~ ~ o -{~ ~ r.:t
Insulation:(°Zj ,y ~„F ~; ~ ~ ,
Drywall: ~ a~ n. w-~v yz., w- ww-
Painting:
~~~
Floor
Coverings: ~ b W CQ~ ~
Plumbing:
c.~ b v ~ t~~ v ~. to
Heating: ~'• /t-~~-`~ ~
Electrical: ~.r, f - ~ t~~. ~(.c~2_ ,
Special Construction
(Manufacturer or Supplier)
Roof Trusses: ~ ~ycl~. ~ (~ ~.
Floor/Ceiling Joists: ~j yl/l ~, ~~~ ~",,~~.~,~
Siding/Exterior Trim: ~ -- ~ l /-y, 4,, ~ ~ ~ t •t...;
Other:
.. .. • •
EXEMPTIONS FROM STATE REGISTRATION
As of January 1, 2006, the City of Rexburg can no longer sell permits without having a copy of your State
registration number or your exemption from the State registration. Please send a copy of your state registration
or fill out this form showing your exemption and send it with your license renewal or your next permit
application.
(This list is a summarization of Idaho Code Title 54 Chapter 5205, for full definitions of these exemptions
please see the State's website at www.ibol.idaho.gov/cont.htm)
^ Currently State licensed pursuant to Title 54 Idaho Code, Chapters:
3 Architects,
10 Electrical Contractors/Journeyman,
12 Engineers/Surveyors,
19 Public Works Contractors (exempt from fee only registration required),
26 Plumbing/Plumbers,
45 Public Works Construction Management Licensing Act (exempt from fee only registration required),
or
50 Installation of heating, ventilation and air conditioning systems
^ Employee or volunteer of a licensed contractor or part of an educational curriculum or nonprofit
charitable activity with no wages or salary
^ Employee of a US Government agency (State, City, County, or other municipality)
^ Public Utility doing construction, maintenance, or development to its own business
^ Involved with gas, oil or mineral operations
^ Supplier doing no installation or fabricating
^ Contracting a project or projects with a total cost less than $2000
^ Operation of a farm or ranch or construction of agriculture buildings exempt from Idaho Building Code
^ Any type of water district operations
^ Work in rural districts for fire prevention purposes
^ Owner who performs work on own property or contracts with a registered contractor to do work as long
as the property is not for resale within 12 months
^ Owner or lessee of commercial property performing maintenance, repair, alteration or construction on
that property
^ Real estate licensee/property manager acting within Idaho Code
^ Engaging in the logging industry
^ Renter working on the property where they live with the property owners approval
^ Construction of a building used for industrial chemical processing per Idaho Code
^ Construction of a modular building (defined by Idaho Code) to be moved out of state
I hereby certify that the above information is true and correct to the best of my knowledge
Signature Date
Print Name
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